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Medical Dermatology

Acne Scarring

What is Acne Scarring?

When acne breakouts penetrate deeper into the skin and become inflamed, the skin and tissue surrounding the blemish become damaged. It is the inflammation and the skin’s response to healing the blemish and surrounding tissue that causes scarring. When the skin produces too little collagen or there is a loss of tissue, the scar will appear indented or recessed. Too much collagen, the protein that gives the skin support, can leave scars with a raised appearance.

Fortunately, not all acne scars are permanent. There are treatments available to help the skin heal itself and improve the surface of the skin. They are performed by a dermatologist or dermatologic surgeon and can be done in a medical office.

Types of Acne Scars

The best course of treatment depends, at least in part, on the type of scar. Patients may have more than one type of scar on their face, back, and chest; in fact, it would be rare for someone with acne scarring to only have one type of scar.

Atrophic Scars

Ice pick: Named after the ice pick tool, these scars follow a similar shape – they are wide at the top and narrow to a point as the scar goes deeper. They are often found in areas where the skin is thinner, such as the forehead and cheeks. Not only are ice pick scars common, but they can also be difficult to treat.

Rolling: The skin is thicker on the lower cheeks and around the jaw and rolling scars you’ll typically find rolling scars in these locations. Rolling scars appear as indents in the skin, and they often have sloping edges. This can make the skin look uneven and wavy.

Boxcar: Boxcar scars have sharp edges that go deep into the skin. As with rolling scars, they are often found on the lower cheeks and around the jaw.

Hypertrophic Scars

Also known as keloid scars, these types of scars are caused when collagen overcompensates when repairing the scar and leaves a raised scar. Usually found on the chest, back and shoulders, they can be tender, painful, or itchy.

Treatment Options

In the natural aging process, we lose collagen in our skin. This loss of collagen can make scars look more prominent. Several treatment methods focus on boosting collagen production and thus improving the appearance of recessed scars. There are also treatments to diminish raised scars.

Steroid Injections

Certain raised scars may benefit from steroid injections. Raised, thick scars can look softer and flatter. The course of treatment begins with once-a-week visits, every few weeks. After that, your dermatologist will determine how often you need to return, which may be as often as every two to six weeks. If the steroid injections are not responding by your fourth visit, your doctor may advise you to try another treatment option.

In addition to corticosteroids, your doctor may recommend other types of medicines that can be injected directly into the scar. These include a chemotherapy medicine called fluorouracil (5-FU) and the targeted cancer drug named interferon.

Chemical Peels

A chemical solution is used to remove the top layer of old skin. The new skin that grows in often has an improved appearance with less noticeable scars. Peels vary in degrees of strength, and the frequency with which you can use them. For instance, only one deep peel is recommended.


In this approach, a dermatologist uses a handheld needle-studded roller across the skin. As the wounds heal, more collagen is produced. Results are gradual and subtle, and typically require three to six treatments for the best results. The interval between treatments ranges from two to six weeks.

Laser Skin Resurfacing

Laser skin resurfacing delivers heat to scarred collagen, breaking it up and allowing for the growth of new, healthy collagen. There are two types of laser resurfacing, and both stimulate collagen growth. Ablative laser resurfacing removes the outermost layer of skin, the epidermis, and uses heat on the dermis. Non-ablative laser resurfacing is non wounding and requires less recovery time, however, the results are less drastic.

Your doctor will consider your skin type and type of scars to determine the best type of method in your case.


Dermabrasion is similar to a chemical peel in that it removes the old layer of skin, but instead of chemicals, it uses a rapidly rotating brush to produce friction. It works best on scars that are flat and not too deep. It is not typically recommended for deep scars.

Dermal Fillers

Dermal fillers can improve the appearance of atrophic (indented) scars by plumping the skin. Soft tissue such as collagen or fat is injected under the skin. Dermal fillers are temporary treatments, and depending on the extent of the scarring, patients may need more than one syringe to achieve optimum results. During a consultation, your doctor will discuss your course of treatment, the type of recommended filler, and how often you would need to return for long-term results.

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